man not sleeping while woman sleeps due to PTSD
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Summary: Yes, PTSD can affect relationships in a variety of ways. A new study shows one way PTSD can affect relationships is by increasing patterns of dysfunctional communication between partners.

Key Points:

  • PTSD – a.k.a. post-traumatic stress disorder – is a clinical mental health disorder caused by unresolved emotions associated with past traumatic experiences.
  • Symptoms of PTSD vary by the individual, but often involve powerful, uncomfortable, and distressing emotions, similar to re-experiencing the initial trauma
  • PTSD symptoms often appear in response to triggers, or things that remind a person with PTSD of the initial traumatic experience
  • The powerful emotions associated with PTSD can lead to non-productive, disruptive patterns of communication

PTSD and Relationships: When Couples Fear Emotions Associated with PTSD

Post-traumatic stress disorder (PTSD) occurs when a person experiences a significant trauma but has not processed the emotions associated with that trauma in a healthy and productive way. Types of trauma that may lead to PTSD include:

  • Experiencing physical, emotional, or sexual abuse
  • Experiencing physical or emotional neglect
  • Witnessing violence: in a war zone, in the community, or at home
  • Being the victim of assault
  • Loss/death of a loved one
  • Serious illness/accidents
  • Natural disasters

Symptoms of PTSD appear in four broad categories:

  1. Intrusive thoughts or memories of the traumatic event, i.e. flashbacks
  2. Behavior focused on avoiding anything related to the traumatic event, or may trigger memories of the event, i.e. avoidant behavior
  3. Significant changes in thought and mood, i.e. sadness, anger, depression
  4. Significant changes in physical/emotional reactions to external stimuli, e.g. shame/sadness, or anger, outbursts, and tantrums

In a study published in late 2024 called “Associations Among PTSD Symptoms, Fear of Emotion, and Couple Communication Difficulties: A Between-Person Dyadic Analysis,” a group of mental health researchers at Penn State University designed an experiment to assess the impact of the fourth category of symptoms we describe above on people in relationships, specifically how emotion and emotional reaction symptoms affect communication.

In the experiment, researchers surveyed 64 mixed-gender couples with a history of trauma – a total of 128 participants – to learn how PTSD impacted their relationship. Here’s how Dr. Steffany Fredman of Penn State, the lead researcher and study author, describes the work:

“We were trying to understand why people with PTSD symptoms have trouble resolving relationship difficulties with their romantic partners. Generally speaking, people with PTSD view themselves and other people negatively, and the resulting mistrust, anger, avoidance, withdrawal and emotional numbing put strain on their romantic relationships.”

Let’s take a look at the problematic communication patterns Dr. Fredman and her team observed as playing a major role in the difficulties experienced by trauma-exposed couples, known by mental health professionals as demand-withdraw styles/patterns.

Demand and Withdraw: Dysfunctional Communication Styles in Partnerships

Here’s a helpful definition of demand-withdraw communication styles, published in the study “Demand-Withdraw Patterns in Marital Conflict in the Home”:

”Demand-withdraw occurs in one of two patterns between marital partners, in which one partner is the demander, seeking change, discussion, or resolution of an issue, while the other partner is the withdrawer, seeking to end or avoid discussion of the issue.”

The authors of hat study identify two types of demand-withdraw communication:

  • Self-demand/partner-withdraw (SDPW):
    • In this variation of demand-withdraw communication, one partner communicates about an issue and needs a reply, while the other responds by withdrawing from the communication.
  • Partner-demand/self-withdraw (PDSW):
    • In this variation of demand-withdraw communication, one partner expresses a need for the other to communicate their thoughts and feelings about an issue, and the other responds by withdrawing from the communication.

In SDPW, the initiator expresses themselves but the other withdraws, while in PDSW, the initiator asks the other to express themselves but the other withdraws. In both types of demand-withdraw communication, one partner initiates and wants to communicate, while the other avoids and doesn’t want to communicate.

Here’s the takeaway from that study:

Both styles are non-productive and can impair healthy communication between partners in a relationship.

When we ask ourselves how PTSD can affect relationships, this is an important place to start. The authors of the study on PTSD use the prevalence of these patterns of as barometers of healthy – or unhealthy communication in partnerships – and focus on the role emotion, especially fear of emotion, can increase levels of demand-withdraw behavior in couples.

To help us understand the results of the study, we’ll take a moment to share some basic facts about PTSD.

PTSD: Prevalence and Consequences of Untreated PTSD

As we mention about, PTSD is a mental health disorder that can occur after an individual experiences a significant trauma. People who develop PTSD experience intrusive thoughts, display avoidance behavior, experience changes in their thoughts and moods, and experience changes in their physical and emotional reactions to external and internal stimuli.

As a reminder, the focus of our discussion is the impact of emotional reactions on communication between partners in couples when one or both partners have PTSD.

Data from the U.S. Department of Veterans Affairs (VA) shows the following prevalence of PTSD among adults in the U.S.:

  • PTSD diagnosis in past 12 months: 5%
  • PTSD during lifetime: 6%
    • Lifetime diagnosis, women: 8%
    • Lifetime diagnosis, men: 4%

That’s 13 million people in any given year with PTSD, and 20 million with a history of PTSD at any point in their lives. When we see those figures, we understand why studying PTSD is important, and begin to get an idea of the number of partnerships it might affect.

When PTSD goes untreated, the individual with PTSD can experience significant emotional and behavioral problems. Issues with the following emotions and behaviors are one of the primary ways PTSD can affect relationships:

  • Depression/sadness
  • Anger regulation/tantrums
  • Pessimism/suspicion
  • Fear

In general, what can happen is that one partner may begin to fear the emotions associated with PTSD, both in themselves and in their partner: that concept is the starting point for the study we introduce in the beginning of this article.

Let’s take a look at the results.

The Impact of PTSD on Relationships: Fear of Emotion

After analyzing data on PTSD symptoms collected from the 64 couples in the study, the study authors observed the following:

  • People with elevated levels of PTSD symptoms reported elevated fear of their emotions
  • Men with PTSD showed a greater likelihood to fear emotions than women

In addition, people with elevated fear of their emotions reported:

  • Low levels of constructive partner-to-partner communication:
    • Men and women with PTSD showed similarly low levels of constructive communication, with no significant differences
  • Higher levels of self-demand/partner-withdraw (SDPW) communication with partners:
    • Women with PTSD reported significantly higher levels of SDPW than men with PTSD
  • Higher levels of partner-demand/self-withdraw communication
    • Women with PTSD reported higher levels of PDSW than men with PTSD

The strongest associations between PTSD, fear of emotion, and communication appeared in:

  1. People with PTSD symptoms who feared emotion and reported high levels of partner-demand/self-withdraw communication. Translation: men with PTSD who fear emotion were more likely to withdraw from conversations when asked about their symptoms or emotions.
  2. Men with PTSD symptoms, women who feared emotion, and women who reported high levels of partner-demand/self-withdraw. Translation: female partners who feared emotion, who were partners of men with PTSD, were more likely to withdraw from conversations men initiated about PTSD symptoms or related emotions.

Here’s how Dr. Fredman characterizes these outcomes:

“[Our findings] suggest that fear of emotions is an important influence on the communication style of couples where one or both people have PTSD symptoms.”

In addition, she observes:

“Experiencing your feelings, trusting people and connecting with others are all important ingredients for healing from PTSD.”

These results beg an important question:

How can people with PTSD work to resolve these obstacles and improve their relationships?

We’ll offer an initial answer to this question below.

How to Reduce the Impact of PTSD on Relationships

Given the available evidence on PTSD, relationships, and communication, we can see there are two components that are likely necessary to mitigate the impact of PTSD on relationships:

  1. Individual therapy. The partner with PTSD needs evidence-based treatment for PTSD. If both partners have PTSD, then both partners need treatment, separately. If both partners fear emotion, both partners can work to resolve this fear – separately – with their therapist. Modes of therapy that help individuals with PTSD include:
  • Cognitive behavioral therapy(CBT)
  • Dialectical behavior therapy(DBT)
  • Trauma-focused cognitive behavioral therapy (TF-CBT)
  • Eye movement desensitization & reprocessing (EMDR) therapy
  • Prolonged exposure (PE) therapy
  • Cognitive remediation therapy (CRT)
  • Acceptance & commitment therapy (ACT
  1. Couples therapy. Couples therapy for people with PTSD that focuses on promoting healthy communication, understanding gender differences in emotional expression/experience, understanding gender differences in communication, and applying lessons from individual therapy – see above – to the partnership. Modes of therapy that help couples resolve problems include:

Again, Dr. Freedman offers valuable insight:

“Couples therapy can effectively reduce PTSD symptoms and improve relationship communication, even in just a single weekend. This latest study reveals…fear of emotions and communication difficulties are connected and why they should be treated at the same time.”

It’s important for both partners in a couple affected by PTSD to understand that treatment for PTSD can work. When both commit to the process – separately and together – they can resolve misunderstandings, repair communication styles, and restore balance and harmony in their relationship.

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.